A randomized controlled trial will be initiated to determine if home care is a cost-effective alternative to combinations of out-patient and institutional care. Approximately 200 patients with chronic obstructive pulmonary disease will be randomly assigned to one of three treatment groups: special home care for COPD patients, regular home care, and no home care. Periodic followup will permit comparisons across groups with reference to cost and benefits. Several hypotheses will be tested: 1) Patients who receive home care use fewer services at lower cost than patients who do not receive home care; 2) Patients who receive home care have higher levels of functional health status, as measured by the Sickness Impact Profile, than do patients who receive no home care; 3) Patients enrolled in the special home care program for COPD patients will have higher functional health status than those enrolled in the regular home care program; 4) Patients enrolled in the special home care program will not differ in their use or cost of services from those enrolled in the regular home care program; 5) Patients in the special home care program will show higher levels of adherence/compliance than those enrolled in the regular home care program or without home care services; 6) There will be no difference in the patients in the three treatment groups ith reference to severity of disease. Data to test these hypotheses will be obtained from three major sources: periodic visits made by the home care nurse; interviews conducted at entry, six months after entry, and at exit from the study; and physician, hospital, and visiting nurse service records. The home care nurse records will provide information in utilization of services, general patient condition, and assessment of compliance; interviews will perceived health status (ADL, SIP), sociodemographic and personal characteristics of the patient, and adherence/compliance information. Record data will provide further information on utilization and patient condition.